Have we lost our way with vaccine monitoring?

We have been selling temperature loggers for vaccines for nearly two decades. Over that time we have seen a huge change in the way that vaccines have been stored.

I’m starting to question whether we’ve lost sight of what the problems were and why we do things.

The problems with the way things used to be

Twenty years ago it was not unusual to see vaccines being stored not only in domestic fridges but in bar fridges with freezers. What this meant was that we had vaccines that were being stored in an item where

we had absolutely no idea what the temperature was

the temperature was poorly regulated

there was a really good chance that the vaccines were freezing.

“Strive for five” to the rescue

“Strive for Five” came along with the emphasis on trying to make sure that vaccines were kept at 5 degrees. At the same time they highlighted that the guidelines were about keeping the fridge between two degrees and eight degrees.

As part of the document they discussed the ways of making a domestic fridge suitable for use in storing of vaccines. It had tips about how to pack it up with water bottles to try and regulate the variations in temperature. It talked about using a min/max thermometer to make sure that you knew that the temperature was correct.

There was a very strong need to check the thermometer regularly because you were relying on a dial that you had absolutely no idea what it meant and to control a fridge where you could not see what the temperature was. If you adjusted the dial you had no idea whether or not you were making it warmer or colder.

As the temperature changed throughout the year, season to season, the performance of the fridge would naturally change as well.

All of these factors combined meant that it was critical to be monitoring your temperature daily. It was critical that you were using a max to monitor to check the temperatures because you needed to make sure that at all times the temperatures were within the range.

Temperature loggers were a great solution for showing what was happening within the fridge throughout the day. It provided more meaningful data than just a min/max temperature and often provided valuable data when things went wrong (and they often did).

What has changed?

Over the past 20 years we’ve seen a total ban on bar fridges with freezers. And to a very large extent, we no longer see domestic fridges being used.

Instead we see vaccine fridges being within the medical industry. This has automatically solved many of the old problems.

The benefits of a vaccine fridge

We now have a fridge with a built in computer. It’s now controlled to turn on and turn off at certain temperatures. Previously you never had control of the lower temperature, only the higher temperature. Now the same fridge has control of the highest and lowest temperature.

This means that a vaccine fridge will no longer accidentally freeze.

Add to this the fact that you’ve got a temperature display on the front of the fridge and your staff know all the time what the temperature of the fridge is.

But here’s the really big change – even if your staff did not know what the temperature was, the fact is that the fridge itself has a built in audible alarm.

Practically, this means as soon as it gets too hot or too cold it will tell you that there is a problem. Your staff don’t actually need to check the fridge anymore to see that there’s a problem because your fridge will do it for you.

All these extra features help ensure that the problems that we faced 20 years ago have largely been dealt with.

Then the question is

Why do we check the temperature?

I think that there is still a huge benefit in having staff check the temperatures once a day to remind them that temperature is important. You want staff to know that they shouldn’t be leaving vaccines out that they know they shouldn’t leave the fridge door open, and that it’s important to put stock into the fridge as quickly as possible. It’s also important for them to know that if the fridge fails if the power fails that there is a critical issue at hand and they need to be considering what to do to keep the vaccines within the fridge safe.

This is about having the right culture. Just checking the temperature won’t create the right culture, but if you have the right culture, it will help support it.

Are temperature loggers are obsolete?

There is still a key role that temperature loggers play in the monitoring of vaccine fridges, but it’s no longer to tell the person whether or not the fridge is okay because the fridge is largely doing that itself.

Instead, the roles of the temperature logger are.

To prove that everything was okay in the fridge.

To give a detailed account of what went wrong if something went wrong. Remember it’s likely to be the fridge that told you in the first place that something went wrong, but it can’t tell you exactly when and for how long.

The temperature logger acts as a policeman. What I mean by that is the temperature logger is a method of validating whether or not your fridge’s temperature is actually correct. There is a chance that your fridge is monitoring the wrong temperature therefore controlling the wrong temperature, and therefore the fridge will be at the wrong temperature.

Then the question is…

How often do we have to check the temperature logger?

There is a big push in the industry to be checking the temperature logger once a day because that’s how often we used to have to check a min/max thermometer.

Here’s the problem – the reason why we were checking a min/max thermometer once a day was because we had no idea what the fridge was doing.

We had no idea if it was failing and we had to be finding that information out as quickly as possible so as to not give too many people vaccines that have frozen and become ineffective.

Now we’ve got a fridge that does all of that.

Then the question is…

How often do we have to police the police?

Any other industry would say that you need to validate a thermometer or a temperature logger typically once a year. The assumption is that a temperature monitoring device is basically fine and just needs the occasional checkup.

Why are we double checking vaccine fridges every single day when the norm within the temperature monitoring industry is typically once a year?

We’re now policing the police once a day just to make sure that they haven’t drifted off. We’re hyper paranoid!

How often do we have to validate that the fridge is doing everything correctly?

Or putting it another way…

How often do we need to download the results from a logger?

In theory you could do it at each audit. Most loggers don’t have sufficient memory and so would require a download prior to overriding data. Once a month or once every six months and you will have the information you need.

I do not recommend that because one of the biggest issues that we still have with temperature loggers is that the battery will fail and you will lose data. You want to download your data frequently enough that you have enough information to prove that your fridge is working effectively.

Practically we advise people to download the results once afortnight, week or month.

And yet there is a demand to download them once or twice a day.

My question is “have we lost our way?”

Have we become too paranoid?

Putting in place a daily check based on the way we’ve always done things means we have actually lost sight of what the problem was that we were trying to fix. Instead, now we’ve got a process that is so much slower and more cumbersome than it was 20 years ago. We’re penalizing people for using a temperature logger when it’s meant to be making life easier.

Let’s use a bit of common sense and work out what we are trying to achieve.